Dietary Diversity and Its Associations with Anemia among Women of Reproductive Age in Rural Odisha, India.

The aim of this study is to examine diet diversity, predictors associated with it, and its associations with anemia among non-pregnant women of reproductive age in rural India. Baseline data from the Reductions in Anemia through Normative Innovations (RANI) project were used and included 980 non-pregnant women aged 15-49 years from Odisha, India. The Food and Agriculture Organization's Minimum Dietary Diversity for Women (MDD-W) was used to assess diet diversity. Anemia was determined by hemoglobin level and categorized as normal (hemoglobin ≥ 12 g/dL), mild (11 ≤ hemoglobin <12 g/dL) and moderate/severe (hemoglobin < 11 g/dL). Multivariable logistic regression was used to examine factors associated with diet diversity, and multinomial logistic regression for associations between diet diversity and anemia. Forty-four percent of women were classified as having a diverse diet (MDD-W ≥5). Women with higher education level, belonging to a scheduled caste (vs. tribe), and higher body mass index had higher odds of a diversified diet (p < .05 for all). A more diverse diet was associated with 30% of lower odds of mild anemia (odds ratio = 0.7, 95% confidence interval: 0.5-0.98, p = .035), however, no statistically significant associations were found for moderate/severe anemia. Diet diversity was inversely associated with prevalence of mild anemia among non-pregnant women of reproductive age in rural India.

Determinants of lower-extremity injury severity and recovery in U.S. High School Soccer Players.

Lower-extremity injuries are common among soccer players, yet few studies have attempted to identify determinants of lower-extremity injury severity and recovery within this group. We aim to identify determinants of lower-extremity injury severity and recovery among high school (HS) soccer players in the US. We used soccer-related injury observations recorded within the NATION-SP during 2011/12-2013/14. Odds of a season-ending game-related injury were higher than a season-ending practice-related injury (Adj. OR = 2.64, 95% CI = [1.39, 5.01]). Gender, setting, and playing surface emerged as significant determinants of any time loss following lower-extremity injuries in multivariable logistic regression models, and multivariable random effects Poisson regression models also revealed significant differences in recovery durations across levels of these variables for "similarly severe" injuries. Findings suggest that gender, injury setting, playing surface contribute to injury corollaries differently. Similar multi-method approaches are needed to identify determinants of injury severity and recovery in this group.

Body mass, cardiorespiratory fitness, and cardiometabolic risk over time: Findings from the Cooper Center Longitudinal Study.

Few studies have adequately assessed the simultaneous effects of changes in cardiorespiratory fitness (fitness) and body mass on cardiometabolic risk. Hence, the current study's aims were twofold: (1) To determine whether increases in body mass result in higher cardiometabolic risk after controlling for fitness changes; and (2) To assess whether increases in fitness result in lower cardiometabolic risk after controlling for weight changes. The study consisted of 3534 patients who came for preventive medicine visits ≥4 times over any 10-year period (1979-2019). The primary independent variables were body mass and fitness, and the dependent variable was metabolic syndrome (MetS) and its components. Mixed-effects regression was used to model the relationship between changes in body mass, fitness, and MetS. Results indicate that increasing body mass up to a 10-year period was significantly related to increasing risk of MetS while controlling for changes in fitness. Specifically, a 1-kg increase in body mass was associated with a 17% (OR = 1.17; 95% CI 1.15-1.19) increased odds for MetS, while adjusting for fitness changes. A 1-MET increase in fitness was related to a 23% (OR = 0.77; 95% CI 0.70-0.84) decrease in odds for MetS, while adjusting for body mass changes up to 10 years. Moreover, body mass change was significantly related to changes in all cardiometabolic components of MetS. Fitness change was significantly associated with changes in MetS components. Future interventions should focus concurrently on increasing fitness and on body mass loss (or maintenance) to improve cardiometabolic health.

Determinants of work capacity (predicted VO2max) in non-pregnant women of reproductive age living in rural India.

BACKGROUND: The negative impact of anemia on work capacity has been studied extensively in male and female workers; however, the simultaneous contributions of confounding variables such as physical activity, as well as other behavioral and sociodemographic characteristics have not been considered. The purpose of this study was to examine cross-sectionally the multivariable correlates of work capacity in non-pregnant women (n = 330) living in rural India. METHODS: The Reduction in Anemia through Normative Innovations (RANI) Project is a norms-based, clustered randomized controlled trial to reduce anemia among women (15-49 years) living in Odisha, India between 2018 and 2021. For the larger trial, 89 clusters of villages were randomized into treatment and control groups on a 1:1 basis. Women (2055/group) living in 15 selected clusters (40-41 villages) were then randomly selected for data collection. The sampling design also randomly-generated a subset (n = 375) of non-pregnant participants who performed a modified Queen's College Step Test (QCST) and who wore an activity monitor for 3 days. Predicted work capacity (VO2max) was determined using the QCST. Levels (h/day) of daily reclining, sitting, standing, walking (steps/day), and energy expenditure (MET∙h/day) were determined using an ActivPAL accelerometer. Hemoglobin concentrations (g/dL) were determined using a HemoCue photometer. Predetermined hierarchical (non-multilevel) regression models tested the independent associations between the primary study variables of interest (physical activity, hemoglobin concentrations) and predicted VO2max, while adjusting for age, body mass index (BMI: kg/m2), education, parity, and dietary diversity score. RESULTS: Approximately 61% of the participants had anemia (Hb < 12 g/dL). Age2 (ß = - 0.01; 95% CI: - 0.01, 0.00), BMI (ß = - 0.19; 95% CI:-0.28, - 0.09), educational attainment (ß = - 1.35; 95% CI: - 2.34, - 0.36), and MET∙h/day (ß = 0.19; 95% CI: 0.00, 0.38) were significant and independent determinants of work capacity. Hemoglobin concentration was marginally associated with work capacity in the presence of the other covariables (ß = 0.22; 95% CI:-0.02, 0.47). CONCLUSIONS: Our data indicate that factors other than anemia are important correlates of work capacity and should be considered when promoting the health and economic capacity of rural Indian women. TRIAL REGISTRATION: Clinical Trial Registry- India (CTRI) http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26285&EncHid=&userName=CTRI/2018/10/016186 on 29 October 2018.

Advancing the global physical activity agenda: recommendations for future research by the 2020 WHO physical activity and sedentary behavior guidelines development group.

BACKGROUND: In July, 2019, the World Health Organization (WHO) commenced work to update the 2010 Global Recommendations on Physical Activity for Health and established a Guideline Development Group (GDG) comprising expert public health scientists and practitioners to inform the drafting of the 2020 Guidelines on Physical Activity and Sedentary Behavior. The overall task of the GDG was to review the scientific evidence and provide expert advice to the WHO on the amount of physical activity and sedentary behavior associated with optimal health in children and adolescents, adults, older adults (> 64 years), and also specifically in pregnant and postpartum women and people living with chronic conditions or disabilities. METHODS: The GDG reviewed the available evidence specific to each sub-population using systematic protocols and in doing so, identified a number of gaps in the existing literature. These proposed research gaps were discussed and verified by expert consensus among the entire GDG. RESULTS: Evidence gaps across population sub-groups included a lack of information on: 1) the precise shape of the dose-response curve between physical activity and/or sedentary behavior and several of the health outcomes studied; 2) the health benefits of light-intensity physical activity and of breaking up sedentary time with light-intensity activity; 3) differences in the health effects of different types and domains of physical activity (leisure-time; occupational; transportation; household; education) and of sedentary behavior (occupational; screen time; television viewing); and 4) the joint association between physical activity and sedentary time with health outcomes across the life course. In addition, we acknowledge the need to conduct more population-based studies in low- and middle-income countries and in people living with disabilities and/or chronic disease, and to identify how various sociodemographic factors (age, sex, race/ethnicity, socioeconomic status) modify the health effects of physical activity, in order to address global health disparities. CONCLUSIONS: Although the 2020 WHO Guidelines for Physical Activity and Sedentary Behavior were informed by the most up-to-date research on the health effects of physical activity and sedentary time, there is still substantial work to be done in advancing the global physical activity agenda.

World Health Organization 2020 guidelines on physical activity and sedentary behaviour.

OBJECTIVES: To describe new WHO 2020 guidelines on physical activity and sedentary behaviour. METHODS: The guidelines were developed in accordance with WHO protocols. An expert Guideline Development Group reviewed evidence to assess associations between physical activity and sedentary behaviour for an agreed set of health outcomes and population groups. The assessment used and systematically updated recent relevant systematic reviews; new primary reviews addressed additional health outcomes or subpopulations. RESULTS: The new guidelines address children, adolescents, adults, older adults and include new specific recommendations for pregnant and postpartum women and people living with chronic conditions or disability. All adults should undertake 150-300 min of moderate-intensity, or 75-150 min of vigorous-intensity physical activity, or some equivalent combination of moderate-intensity and vigorous-intensity aerobic physical activity, per week. Among children and adolescents, an average of 60 min/day of moderate-to-vigorous intensity aerobic physical activity across the week provides health benefits. The guidelines recommend regular muscle-strengthening activity for all age groups. Additionally, reducing sedentary behaviours is recommended across all age groups and abilities, although evidence was insufficient to quantify a sedentary behaviour threshold. CONCLUSION: These 2020 WHO guidelines update previous WHO recommendations released in 2010. They reaffirm messages that some physical activity is better than none, that more physical activity is better for optimal health outcomes and provide a new recommendation on reducing sedentary behaviours. These guidelines highlight the importance of regularly undertaking both aerobic and muscle strengthening activities and for the first time, there are specific recommendations for specific populations including for pregnant and postpartum women and people living with chronic conditions or disability. These guidelines should be used to inform national health policies aligned with the WHO Global Action Plan on Physical Activity 2018-2030 and to strengthen surveillance systems that track progress towards national and global targets.

Determinants of concussion diagnosis, symptomology, and resolution time in U.S. high school soccer players.

Determinants of concussion diagnosis, symptomology, and other sequelae have not been examined in high school soccer players. Using a sample of soccer-related head/neck injuries from the NATION Surveillance Program, we evaluated potential determinants (sex, injury history, injury mechanism, setting) of concussion characteristics. A total of 378 head/neck injuries were recorded, and 189 (50.0%) injuries from this sample, resulted in a concussion diagnosis. Odds of concussion diagnosis were 84% higher among female players compared with their male counterparts, and over two-fold higher in game settings compared with practice settings. We also observed several significant symptom dependencies, such as higher odds of difficulty concentrating (OR = 5.84, 95% CI = [2.99, 11.42]) given concurrent light sensitivity. Furthermore, we identified injury mechanism as a determinant of concussion symptom resolution time. Our results suggest that determinants of soccer-related concussions and their sequelae are multifactorial, and extend the existing literature with the potential to inform clinical practice.

The joint associations of weight status and physical activity with mobility disability: The NIH-AARP Diet and Health Study.

BACKGROUND/OBJECTIVES: The purpose of this study was to determine the joint associations of weight status and physical activity with mobility disability in older men and women. SUBJECTS/METHODS: We analyzed prospective data from 135,220 participants in the NIH-AARP Diet and Health Study between 1995-1996 and 2004-2005. METHODS: Height and weight, as well as light- and moderate-to-vigorous-intensity physical activity typical of the past 10 years (h/week) were self-reported at baseline, and body mass index (BMI: kg/m2) was categorized into normal weight (BMI 18 to <25 kg/m2); overweight (BMI 25 to <30 kg/m2); and obese (BMI ≥ 30 kg/m2). Mobility was assessed by self-report at follow-up and mobility disability was defined as reporting "unable to walk" or an "easy usual walking pace (<2 mph)". Multivariable logistic regression determined the independent and joint associations of weight status and total physical activity with the odds of mobility disability. RESULTS: Twenty-one percent of men and 37% of women reported a mobility disability at follow-up. We observed a curvilinear dose-response association between increasing categories of weight status and mobility disability within each tertile of physical activity, with the highest odds experienced by men and women with overweight (OR = 2.45; 95%CI: 2.25, 2.67 for men and OR = 2.99; 95%CI: 2.78, 3.22 for women) and obesity (OR = 3.93; 95%CI: 3.58, 4.32 for men and OR = 5.08; 95% CI: 4.65, 5.54 for women) in combination with low physical activity. Moreover, among those reporting 7 or fewer hours/week of total physical activity, being of normal body weight did not eliminate the excess odds of mobility disability. CONCLUSIONS: These findings highlight the combined importance of obesity prevention and physical activity promotion to mobility in older age. Given aging demographics and the global economic burden associated with aging- and disuse-related disability, there is tremendous public health benefit to understanding how various modifiable determinants of mobility disability can interact in older age.

Association Between Muscle Strength and Modeling Estimates of Muscle Tissue Heterogeneity in Young and Old Adults.

OBJECTIVES: Assessing aging muscle through estimates of muscle heterogeneity may overcome some of the limitations of grayscale analyses. The objectives of this study included determining statistical model parameters that characterize muscle echogenicity and are associated with strength in younger and older participants. METHODS: Thirty-three community-dwelling participants were assigned to younger and older groups. Quantitative B-mode ultrasound scanning of the rectus femoris and isometric grip strength testing were completed. Shape or dispersion parameters from negative binomial distribution, Nakagami, gamma, and gamma mixture models were fitted to the grayscale histograms. RESULTS: The mean ages ± SDs of the younger and older groups were 24.0 ± 2.3 and 65.1 ± 6.5 years, respectively. Statistical model shape and dispersion parameters for the grayscale histograms significantly differed between the younger and older participants (P = .002-.006). Among all of the statistical models considered, the gamma mixture model showed the best fit with the grayscale histograms (χ2 goodness of fit = 62), whereas the Nakagami distribution displayed the poorest fit (χ2 goodness of fit = 2595). Grayscale values were significantly associated with peak grip strength force in younger adult participants (R2 = 0.36; P < .008). However, the negative binomial dispersion parameter k (adjusted R2 = 0.70; P < .001) and gamma shape parameter α (adjusted R2 = 0.68; P < .01) showed the highest associations with peak grip strength force in older adult participants. CONCLUSIONS: The negative binomial dispersion parameter k and the gamma shape parameter α have clinical relevance for the assessment of age-related muscle changes. Statistical models of muscle heterogeneity may characterize the association between muscle tissue composition estimates and strength better than grayscale measures in samples of community-dwelling older adults.

Understanding Health, Violence, and Acculturation Among South Asian Women in the US.

The devastating effects of experiencing violence in childhood are seen well into adulthood. This has been particularly difficult to assess among South Asians living in the U.S., due to a lack of disaggregated data on this ethnic group. In a web-based survey administered to a convenience sample of South Asian women living in the U.S. (n = 535), information was gathered on experience/exposure to childhood violence; adult intimate partner violence; and adverse health outcomes, including ever suicide ideation/attempt, experiences of quality of life and body esteem in adulthood. Further, an individual's acculturation levels were measured specifically looking at cultural identity which was guided by Berry's biculturalism model. This study found that acculturation status is a key factor with respect to childhood verbal, physical, and sexual abuse, as well as body esteem and an individual's well-being. These results suggest that acculturation plays a key role for childhood violence, as well as key adult health indicators. The findings in this study, suggest that more research is warranted to better understand the complex relationships between acculturation status and health. While studies of South Asian immigrants have increased substantially, the study on how acculturation influences family violence and health outcomes has lagged behind. The findings in this study will provide guidance for future work in understanding how acculturation can play a key role in addressing the health and well-being of South Asian women in the U.S.

A single bout of resistance exercise does not promote excess postexercise energy expenditure in untrained young men with a family history of diabetes.

BACKGROUND: People with a family history of type 2 diabetes have lower energy expenditure (EE) and more obesity than those having no such family history. Resistance exercise (RE) may induce excess postexercise energy expenditure (EPEE) and reduce long-term risk for obesity in this susceptible group. PURPOSE: To determine the effect of RE on EPEE for 15 hr after a single exercise bout in healthy, untrained young men having a family history of type 2 diabetes. DESIGN: Seven untrained men (23 ± 1.2 years, BMI 24 ± 1.1) completed a 48-hr protocol in a whole room calorimeter. The first day served as a control day, with a moderate 40-min RE bout occurring on the second day. Differences in postexercise EE were compared with matched periods from the control day for cumulative 15-min intervals (up to 150 min) and 15 hr after the RE bout was completed. RESULTS: The most robust difference in EPEE between the experimental and control days was observed in the first 15-min postexercise period (M = 1.4Kcal/min; SD = 0.7; p < .05). No statistically significant differences in EPEE were noted beyond 90-min of continuous measurement. CONCLUSIONS: Young people with a family history of type 2 diabetes may not show EPEE after a single RE bout when observed for 15 hr after RE and long-term resistance training may be required to promote EPEE.

'Sedentary behaviour counselling': the next step in lifestyle counselling in primary care; pilot findings from the Rapid Assessment Disuse Index (RADI) study.

BACKGROUND: Accumulating evidence emphasises a relationship between prolonged sitting and increased risk for cardiometabolic disorders and premature death irrespective of the protective effects of physical activity. Primary care physicians have the potential to play a key role in modifying patients' sedentary behaviour alongside physical activity. METHODS: A pilot study examining sedentary behaviour and physical activity counselling in a primary care clinic. A total of 157 patients completed a detailed survey related to lifestyle counselling received from their primary care physician. We analysed these responses to describe counselling practices within the 5A framework, and to examine correlates (ie, patients' demographics, sedentary behaviour and physical activity and clinical variables) related to receiving counselling. RESULTS: A total of 10% received general advice to decrease sitting time, in comparison with 53% receiving general physical activity counselling. None, however, received a written plan pertaining to sedentary behaviour whereas 14% received a written physical activity prescription. Only 2% were provided with specific strategies for sedentary behaviour change in comparison with 10% for physical activity change. Multivariable analysis revealed that patients who were obese were more likely to receive counselling to decrease sitting (OR=7.0; 95% CI 1.4 to 35.2). In comparison, higher odds for receiving physical activity counselling were associated with being younger, aged 40-59 years (OR=2.4; 95% CI 1.1 to 5.4); and being a non-smoker (OR=6.1; 95% CI 1.3 to 28.4). CONCLUSIONS: This study is the first to assess sedentary behaviour counselling practices in primary care and such practices appear to be infrequent. Future research should attempt to establish a 'knowledge base' to inform development of sedentary behaviour interventions, which should be followed by testing feasibility, efficacy, and subsequent effectiveness of these programmes in a clinical setting.

Sedentary behaviour and physical inactivity assessment in primary care: the Rapid Assessment Disuse Index (RADI) study.

BACKGROUND: The emerging evidence of the effects of sedentary time on health outcomes suggests a need to better measure this exposure. Healthcare settings, however, are not equipped with a tool that can quickly assess the sedentary habits of their patient population. The purpose of this study was to validate a tool for rapidly quantifying and tracking the sedentary time and low levels of daily lifestyle physical activity among primary care patients. METHODS: The study examined the test-retest reliability and validity of the rapid assessment disuse index (RADI) among adult patients from a large primary care clinic. Patients completed RADI (comprised of 3 items: sitting, moving and stair climbing) twice, followed by accelerometer monitoring. Test-retest reliability was computed, and the correlation between survey responses and accelerometry was determined. A receiver operating characteristic curve was constructed and the area under the curve (AUC) was calculated. RESULTS: RADI was temporally stable (intraclass correlation coefficients 0.79), and a higher score was significantly correlated with greater sedentary time (ρ=0.40; p<0.01), fewer sedentary to active transitions (ρ=-0.42; p<0.01), and less light-intensity physical activity (ρ=-0.40; p<0.01). The ability of RADI to detect patients with high levels of sedentary time was fair (AUC=0.72). CONCLUSIONS: This brief assessment tool, designed to quickly identify patients with high levels of sitting and low daily physical activity, exhibits good reliability and moderate validity. RADI can assist in providing recommendations at the point of care pertaining to modifying sedentary behaviour.

The Effects of the RANI Project on 6-Month Physical Activity Among Women Living in Rural India: A Randomized-Controlled Trial.

Background: Anemia is associated with fatigue, low physical activity, and poor quality of life. The purpose of this study was to determine the effects of a field trial on 6-month change in anemia and physical activity among nonpregnant women living in rural India. Methods: The Reduction in Anemia through Normative Innovations (RANI) Project is a cluster randomized controlled trial of a social norms-based intervention to reduce anemia among women (15-49 years). Participants (n = 292) performed a modified Queen's College Step Test (QCST) and wore an ActivPAL accelerometer for 3 days. Hemoglobin concentrations (g/dL) were determined using a HemoCue 301 photometer. Linear regression tested the effects of the intervention on 6-month change in hemoglobin and physical activity, while adjusting for age, body mass index, education, parity, and predicted VO2max. Results: We observed no differences in hemoglobin (11.8 ± 1.2 vs.11.6 ± 1.4 g/dL) or overall physical activity (36.6 ± 2.1 vs. 35.3 ± 5.8 metabolic equivalent of task-hours/day) at 6 months between the treatment and control groups, respectively. In contrast, steps/day was significantly higher in the treatment, compared with the control group (ß = 1353.83; 95% confidence interval: 372.46, 2335.31), independent of other covariables. Conclusions: The potential to modify walking and other health-seeking behaviors using a social norms approach is worthy of further investigation among women living in rural India.Clinical Trial Registry - India: CTRI/2018/10/016186.

Domains of Sedentary Behavior and Cognitive Function: The Health, Aging, and Body Composition Study, 1999/2000 to 2006/2007.

BACKGROUND: This study examines the relationship between various domains of sedentary behavior and subsequent cognitive function to evaluate whether different sedentary activities have specific associations with future cognitive performance. METHODS: Data were from 1 261 older adults participating in the Health, Aging, and Body Composition (Health ABC) Study between 1999/2000 and 2006/2007. Total sitting time (hours/day), reading time (hours/week), and TV time (≤27/≥28 h/wk) were self-reported at baseline and 3 years later. At follow-up, cognitive function was evaluated using the Teng Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST). Multivariable linear regression modeling examined the independent associations of baseline sedentary behaviors and 3-year change in those behaviors with cognitive function scores at follow-up, adjusting for important covariables. RESULTS: Baseline total sitting time was positively associated with 3MS (ß = 0.14 ± 0.07; p < .05) and DSST (ß = 0.20 ± 0.10; p < .05) scores at follow-up, as was reading time (ß = 0.09 ± 0.03; p < .05 for 3MS score and ß = 0.14 ± 0.04; p < 0.01 for DSST score). Participants who increased their TV watching time over 3 years had a significantly lower 3MS score (ß = -1.45 ± 0.71; p < .05) at follow-up, compared with those who maintained a low level of TV time (referent). These findings were independent of age, sex, race, education level, health status, depressive symptoms, and physical activity. CONCLUSION: Some types of sedentary behavior may have benefits for cognitive function in older age, thus highlighting the importance of measuring different domains of sitting time.

Pandemic-Related Life Events and Physical Inactivity During COVID-19 Among Israeli Adults: The Smoking and Lifestyles in Israel Study.

BACKGROUND: Public health measures to contain the COVID-19 pandemic have led to disruptions in daily life, such as job loss and changes in activity. The present study examines the relationship between pandemic-related life events and disuse (prolonged sitting coupled with inactivity) among adults. METHODS: A cross-sectional study of 4084 adults in Israel (September 2020). The primary independent variables were pandemic-related life events, such as job loss. The primary dependent variable was disuse as measured by the Rapid Assessment Disuse Index (RADI). The RADI was examined continuously and dichotomously as a low RADI score (<26: yes/no). RESULTS: Linear regression indicated that experiencing a major life event during the pandemic was associated with lower RADI scores (-1.04; 95% confidence interval, -1.48 to -0.61). Similarly, logistic regression revealed that those experiencing a major life event had 1.18 (95% confidence interval, 1.03 to 1.34) times greater odds for low RADI scores in comparison to those not experiencing an event. CONCLUSIONS: Experiencing pandemic-related major life events was linked to less sitting time and increased activity levels among Israeli adults. Future research should examine underlying mechanisms explaining this relationship to facilitate the design and implementation of targeted interventions.

Personalized versus generic digital weight loss interventions delivered on university campuses: a 6-month cost-benefit analysis.

Cost-effectiveness analyses of weight loss programs for university students can inform administrator decision-making. This study quantifies and compares the costs and cost-effectiveness of implementing two digitally-delivered weight loss interventions designed for university populations. Healthy Body Healthy U (HBHU) was a randomized controlled trial comparing TAILORED (personalized) versus TARGETED (generic) weight loss interventions adapted specifically for young adults to a CONTROL intervention. Participants (N = 459; 23.3 ± 4.4 years; mean BMI 31.2 ± 4.4 kg/m2) were recruited from two universities. Implementation costs were examined from a payer (i.e., university) perspective, comparing both the average cost effectiveness ratio (ACER) and the incremental cost effectiveness ratio (ICER) of the two interventions. Cost-effectiveness measures were calculated for changes in body weight, abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c. The overall 6-month implementation costs were $105.66 per person for the TAILORED intervention and $91.44 per person for the TARGETED intervention. The ACER for weight change was $107.82 for the TAILORED and $179.29 for the TARGETED interventions. The ICER comparing TAILORED with TARGETED for change in body weight was $5.05, and was even lower ($2.28) when including only those with overweight and not obesity. The ICERs for change in abdominal circumference, HDL cholesterol, systolic and diastolic blood pressure, and HbA1c were $3.49, $59.37, $1.57, $2.64, and $47.49, respectively. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention, particularly among those with overweight. Young adults with obesity may require more resource-intensive precision-based approaches.

Knowledge about the cost-effectiveness of weight loss programs for university students is needed to inform administrator decision-making regarding whether to provide such programming. This study examined the cost-effectiveness of two digitally-delivered weight loss interventions (i.e., TAILORED and TARGETED) designed for university students. The TAILORED intervention included information tailored to the individual, while the TARGETED intervention included only generic weight loss information. At 6 months, the average cost per kilogram of weight loss was $107.82 for TAILORED participants and $179.29 for TARGETED participants. The TAILORED intervention was generally more cost-effective compared with the TARGETED intervention.

Effects of Low-Calorie Sweetener Restriction on Glycemic Variability and Cardiometabolic Health in Children with Type 1 Diabetes: Findings of a Pilot and Feasibility Study.

Low-calorie sweeteners (LCS) are commonly consumed by children with type 1 diabetes (T1D), yet their role in cardiometabolic health is unclear. This study examined the feasibility, acceptability, and preliminary effects of 12 weeks of LCS restriction among children with T1D. Children (n = 31) with T1D completed a two-week run-in (n = 28) and were randomly assigned to avoid LCS (LCS restriction, n = 15) or continue their usual LCS intake (n = 13). Feasibility was assessed using recruitment, retention, and adherence rates percentages. Acceptability was assessed through parents completing a qualitative interview (subset, n = 15) and a satisfaction survey at follow-up. Preliminary outcomes were between-group differences in change in average daily time-in-range (TIR) over 12 weeks (primary), and other measures of glycemic variability, lipids, inflammatory biomarkers, visceral adiposity, and dietary intake (secondary). Linear regression, unadjusted and adjusted for age, sex, race, and change in BMI, was used to compare mean changes in all outcomes between groups. LCS restriction was feasible and acceptable. No between-group differences in change in TIR or other measures of glycemic variability were observed. However, significant decreases in TNF-alpha (-0.23 ± 0.08 pg/mL) and improvements in cholesterol (-0.31 ± 0.18 mmol/L) and LDL (-0.60 ± 0.39 mmol/L) were observed with usual LCS intake, compared with LCS restriction. Those randomized to LCS restriction did not report increases in total or added sugar intake, and lower energy intake was reported in both groups (-190.8 ± 106.40 kcal LCS restriction, -245.3 ± 112.90 kcal usual LCS intake group). Decreases in percent energy from carbohydrates (-8.5 ± 2.61) and increases in percent energy from protein (3.2 ± 1.16) and fat (5.2 ± 2.02) were reported with usual LCS intake compared with LCS restriction. Twelve weeks of LCS restriction did not compromise glycemic variability or cardiometabolic outcomes in this small sample of youth with T1D. Further examination of LCS restriction among children with T1D is warranted.

What moves young people? Applying the risk perception attitude framework to physical activity behavior and cardiometabolic risk.

Cardiometabolic disease risk factors, including metabolic syndrome and physical inactivity, are prevalent among young adults. However, few young adults are aware of their risk status. The risk perception attitude (RPA) framework was used to categorize participants (n = 456) enrolled in a three-arm randomized controlled weight management trial by their baseline values of cardiometabolic risk perceptions and physical activity self-efficacy. Trial recruitment occurred at two universities from 2015 to 2018 and participants were randomly assigned to one of three weight management interventions: Tailored, Targeted, Control. Cross-sectional and longitudinal analyses were conducted to examine associations between RPA category (i.e., Responsive, Indifferent, Avoidant, Proactive) and physical activity behavior. At baseline, the Responsive group had the highest amount of physical activity (mean [95% CI]: 379.2 [332.6 to 425.8] min/week), the Indifferent group had the lowest (296.7 [261.98 to 331.32] min/week), and the Avoidant/Proactive groups showed intermediate values. Over 6 months, there was a significant interaction between RPA group and intervention arm on change in physical activity adjusted for age, sex, race/ethnicity, baseline body mass index, and baseline moderate-to-vigorous physical activity (p = .017). Among Tailored intervention participants only, the Proactive participants were the only group to have an increase in physical activity (19.97 min/week) and the Indifferent participants had the most significant decrease in physical activity (127.62 min/week). Results suggest the importance of early screening for young adults to help raise awareness of cardiometabolic risk and ultimately support them in health promotion efforts.